- ACS in elderly man vasculopath with Skeleton and skin
- Stent thrombosis or Restenosis: the dilemma of an equivocal STEMI patient
- Transaxillary transcatheter aortic valve implantation (TAVI) as valve-in-valve procedure due to degeneration of an aortic bioprosthesis
- A chronic total occlusion (CTO) of ostial LAD in a young patient
- Percutaneous LAA closure in an elderly woman with contra-indication to oral anticoagulant therapy
- Antithrombotic strategy during PCI: challenging situations
- Multivessel disease and cardiac arrest
- A Large Atrial Septal Defect in a 59 year old male patient
Nurses and Technicians
nguyen huy – December 22, 2014
“thanks for this case. I think the problem in this case is the low BP of patient. and IC adre imp...”
tamim kanaan – December 20, 2014
“Denying CABG by the patient , PCI to LM-LAD and trying to open the RCA with the good retrograde f...”
Iyad Albaghdadi – December 20, 2014
“As there is retrograde for RCA, it's reasonable to attempt open it first, and later PCI for LM an...”
muhammad irfan – December 20, 2014
“He has unprotected LMS which has distal disease and critical proximal disease in LAD. RCA and LCx...”
Attila Thury – December 16, 2014
“"Thank your for the question. Theoretically, future repeat intervention will be "easy" once the p...”
- Institut Cardiovasculaire Paris Sud Massy - France
- CTO of ostial LAD (retrograde technique)
CTO of ostial LAD (retrograde technique)
- Live center: Institut Cardiovasculaire Paris Sud Massy - France
- Operators: Osamu KATOH, T. LEFEVRE, Mohamed ABDELLAOUI
- Patient: CC, 72 y.o.
- Type of procedure: Coronary
- Level: Complex
- Access type: Retrograde, Femoral
Euroscore: 3 (predicted mortality from CABG: 2.1)
Silent myocardial ischemia
Positive stress test
- Length: 40
- Retinal vessel diameter: 3.5
- Lesion subset: Chronic total occlusion of ostial LAD with collateral circulation from the RCA
- Therapeutic techniques: Retrograde approach
Retrograde approach via the septal collaterals ?
Should we attempt this lesion ?
What is the optimal approach to this kind of lesion ?
How to perform the retrograde approach ?
|Maverick 2 ™ Monorail||Balloon||2 x 20||x 1|
|Maverick||Balloon||2.5 x 23||x 1|
|Maverick||Balloon||3 x 20||x 1|
|Promus||Stent||2.5 x 28||x 1|
|Promus||Stent||2.5 x 23||x 1|
|CORDIS, a Johnson & Johnson Company|
|Dura Star||Balloon||3 x 15||x 1|
|Cypher Select||Stent||2.5 x 28||x 1|
|Lacrosse Balloon||Balloon||1.3 x 10||x 1|
|ASAHI NEO´S||Guide wire||x 3|
|X-treme wire||Guide wire||x 1|
|JR 4 7F||Catheter||x 1|
|EBU 4 8F||Catheter||x 1|
|Femoral 7F||Introducer Sheath||x 1|
|Femoral 8F||Introducer Sheath||x 1|
|Finecross 1.8F||Catheter||x 1|
Take home message
Safety and effectiveness of the retrograde approach in selected cases of chronic occlusion
MSCT demonstrated that the occlusion was of the mid LAD after the first diagonal branch
EBU 4.0 8F guiding catheter in LMS. BMW wire in first diagonal. IVUS examination of proximal LAD to locate entry into true lumen.
24/05/2007: RCA cannulation with JR4 7F guiding catheter in preparation for retrograde approach caused ostial dissection - treated by deployment of a single 4.5 x 24mm PROMUS stent
1st and 2nd diagonal branches wired via antegrade approach. Unable to advance wire into true lumen of LAD. Via retrograde approach, balloon dilatation of septal branch and then wire advanced back through LAD occlusion and into guiding catheter.
Distal LAD lumen now visualised and wire advanced antegradely
Predilatation of proximal and mid LAD and bifurcation (kissing inflation 2.5 and 2.0mm Maverick). Stenting of Mid LAD: PROMUS 2.5 X 28mm, then 2.5 x 23mm PROMUS distally.
After final kissing inflation: LAD 3mm, Diagonal 2.5mm Maverick; Final good angiographic result in LAD and diagonal. Distal LCX treated with PROMUS 2.5 x 15mm afterwards.
Patient currently asymptomatic.Normal dobutamine stress echocardiogram.Angiography at 9 months satisfactory showing no restenosis.
Second view of good result of ostial LAD stenting at 9 months.